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Renal function more than twenty years after cisplatin-based chemotherapy fortesticular cancer

(2016) Donkerbroek,J.W. (Jan Willem)

Background
The introduction of platinum-based chemotherapy for treatment of metastatic testicular cancer in the late 1970s has led to an increase in survival rates and a growing cohort of testicular cancer survivors. Consequently, attention for long-term adverse effects of treatment has increased. Nephrotoxicity is an important adverse effect of platinum-based chemotherapy. However, data on renal function more than 20 years after treatment is lacking.
Aims
1. To assess renal function and glomerular damage in very long term survivors of testicular cancer treated with cisplatin combination chemotherapy, compared with an age-matched control group who have not been treated for any type of cancer.
2. To investigate disease and treatment characteristics of testicular cancer associated with decreased renal function.
3. To investigate comorbidities and cardiovascular risk factors associated with decreased renal function.
Methods
Renal function, measured by mean creatinine clearance (CRCL) of two 24-hour urine collections, was assessed in 54 patients treated with platinum-based chemotherapy for testicular cancer between 1977 and 1996 and compared with a group of 27 healthy controls. Glomerular damage was measured by albuminuria and proteinuria and compared between the two groups. Furthermore, disease and treatment characteristics, comorbidities and cardiovascular risk factors were evaluated.
Results
Median CRCL in 54 chemotherapy-treated testicular cancer survivors was 102.8 ml/min/1.73m2 versus 125.8 ml/min/1.73m2 in healthy controls (p<0.001). 20 participants had a CRCL <90 ml/min/1.73m2, of which nineteen (95%) were treated with chemotherapy (p=0.002). No significant difference in presence of albuminuria and proteinuria was observed. Cumulative dose of cisplatin did not correlate with CRCL (spearman’s rho=0.006, p=0.967). In testicular cancer survivors, CRCL before start of chemotherapy was the only factor associated with a decreased renal function, after a median follow-up of 27 years. No differences in comorbidities and cardiovascular risk factors were observed in patients with a decreased and normal renal function.
Conclusion
Renal function in patients treated with platinum-based chemotherapy for testicular cancer more than 20 years ago is decreased compared to healthy controls. After a median follow up of 27 years, over a third of patients treated with platinum-based chemotherapy showed a decreased renal function (CRCL <90 ml/min/1.73m2). Renal function before start of chemotherapy is an important predictor for renal function in the long-term. Further research in relation to treatment related collateral damage and strategies for prevention of cisplatin-induced nephrotoxicity is needed.





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